Safety of care

Winding down your practice

While it appears that physicians are retiring later and many are phasing-in their retirements,1 eventually all members must face the decision of when and how best to retire.

Notifying patients

It can be difficult for physicians to discuss their pending retirement with patients, especially patients they have treated for years. News that a favoured or long-time physician will be retiring is often difficult information for patients to receive. For this reason, it is important to provide as much notice as possible of a pending retirement to patients and their families.

Reasonable notice gives the patient time to adjust to the news and to seek out a new doctor. Given the demand for physicians across the country, patients are better served by a longer notification period. Effective ways to notify patients include a notification letter to each patient, a notice posted in the office, a voicemail message about the planned retirement, and even a notice in a local newspaper. Physicians with websites could also consider this communication vehicle.

When physicians close or transfer a practice, some patients may ask to have their medical records transferred. This should be done in a timely fashion. Physicians must obtain authorization from the patient before a copy of the medical record is transferred. In most jurisdictions, an appropriate and reasonable fee may be charged for copying and transferring files. Physicians should check on the exact requirements for transferring records and charging fees in their province or territory.

Doctors should review their medical regulatory authority (College) guidelines regarding the transfer and retention of medical records. Physicians should retain the original records, whether in paper or digital form, for a period of at least 10 years from the date of last entry or, in the case of minors, 10 years from the time they would have reached the age of majority. Retiring physicians are responsible for the retention and safe storage of records. In a group practice, the retiring physician should be clear about retention of records by the group, as well as future access to the medical records.

Continuity of patient care

Retiring physicians should attempt to transfer their patients to another physician in the community. Some patients may prefer to find their own new doctor. Physicians should try to assist the patient in this search process. Some Colleges and certain municipal authorities maintain lists of physicians accepting new patients. Physicians should document these discussions and decisions with patients in the medical record.

It is especially important to attempt to make arrangements for alternate care and follow up for patients who require it. Special attention should be given to patients who are being actively investigated or treated. All work in progress should be reviewed and appropriately acted upon. This will help to avoid delayed or missed diagnoses.

Physicians working in rural and remote settings may find it particularly hard to transfer patient care to another doctor. In these cases, physicians should inform regional health authorities to try to assist in the development of a suitable plan. Sharing information about retirement dates, patient needs, and patient caseload can help the health region attract new physicians or find locum tenens. Since the loss of rural doctors can be particularly harsh for small communities, it is important to provide advance notice of retirement plans. In addition, physicians who are willing to talk to prospective replacement doctors can help regional health authorities in the recruitment process.

Informing others

Physicians planning their retirement should inform their colleagues, partners, and employees in a timely manner. Healthcare organizations such as hospitals and specialty medical centres (e.g. mental health or cancer) should also be informed, as should other healthcare professionals such as local pharmacists. In many cases, this additional step can help to ensure continuity of care for patients.

If a retiring physician wants to continue practising any medical acts, even on a very limited basis, the physician must maintain a license. Most Colleges do not have a retired category for their members. Many Colleges require members to resign when they quit or retire from practice. This ends their license and a physician would have to reapply under the current requirements to resume any practice.

If a physician wants to retire completely from medicine, then written notification should be sent to the licensing body, the provincial or territorial paying agency, and professional associations. The CMPA should also be informed of a member's retirement, as well as any plans by a member to do a different type of medical work or even part-time medical practice. Health plans, accountants, suppliers, and landlords should also be notified.2

If you are an owner or partner in a clinic or medical facility and intend to retire, this generally requires maintaining a license to practice as well as CMPA membership until you divest your interest. Members who wish to maintain an ownership interest in a clinic or medical facility on retirement should call the CMPA.

Some physicians may be practising under employment or contractual arrangements with hospitals or health authorities. In these cases, physicians should review their contract or service agreements to fully understand their responsibilities leading up to and at the time of retirement. Physicians should discuss their contract with their personal legal counsel before retirement. Physicians who have contracts with research organizations, governments, or healthcare agencies should do the same.

CMPA Protection — Peace of mind throughout retirement

Physicians will be comforted to know that CMPA protection continues, even in retirement. Because the CMPA provides occurrence-based protection, if a medico-legal difficulty arises for care provided while a CMPA member, physicians remain eligible for assistance. In fact, the physician's estate is eligible for protection, as long as the difficulty pertains to care provided while the physician was a CMPA member.

Physicians planning their retirement should take the time necessary to make this important change as easy as possible. Advance preparation and notice to patients will benefit all parties. Some patients may take the news of a physician retirement particularly hard. If a physician senses difficulty transitioning care, or if the patient is making the situation unnecessarily challenging, members should call the CMPA for advice.

Physicians may also be interested in the Association's article, "Considerations when leaving a medical practice." Physicians with specific questions or concerns should contact the CMPA directly. Experienced medical officers can provide guidance to help ensure a smooth transition for all parties.

References

Canadian Institute for Health Information, R.W. Pong, PhD, "Putting Away the Stethoscope for good? Toward a New Perspective on Physician Retirement," April 2011, p. 20.

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.